Provider Demographics
NPI:1902386196
Name:RICHIE, KATHRYN ROSE (LCSW, CADC)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ROSE
Last Name:RICHIE
Suffix:
Gender:F
Credentials:LCSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 N WOOD ST # 2N
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-2011
Mailing Address - Country:US
Mailing Address - Phone:507-210-9769
Mailing Address - Fax:
Practice Address - Street 1:1800 N HERMITAGE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-1161
Practice Address - Country:US
Practice Address - Phone:312-948-6533
Practice Address - Fax:312-382-1612
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0203121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical